* Child’s Surname
* Child’s Forename
Know as
* Address
* Postcode
* Telephone
* Date of Birth
* Parent Name (1)
* Mobile No
Work Number
Place of work/Department
* Home Number
* Email
Parent Name (2)
Mobile No
Home Number
Email
* Does your child have any know allergies or medical conditions Yes No
If yes, please specify
* Correspondence to be addressed to
Date placement Required
Please choose sessions required: AM being 7:30 – 1:00pm/_ day being 8:45am – 3:30pm/ Full day being 7:30am – 6:15pm/PM being 1:00pm – 6:15pm/
Monday AM Day Full Day PM
Tuesday AM Day Full Day PM
Wednesday AM Day Full Day PM
Thursday AM Day Full Day PM
Friday AM Day Full Day PM
Your child may have their photograph taken with Kiddies Corner. If you do not want your child’s photo to be used in Kiddies Corner literature.
Please tick here:
By submitting this form I/we confirm that we are applying for a place on the Kiddies Corner terms which I/we have read. Upon a place being made available I/we shall provide a cheque for £50.00 for the booking fee which I understand is non-refundable until my child leaves Kiddies Corner or may be used to reduce any outstanding debts by me/us to Kiddies Corner when my child leaves.